Methods of conditioning sheet bioprosthetic tissue

ABSTRACT

Methods for the conditioning of bioprosthetic material employ bovine pericardial membrane. A laser directed at the fibrous surface of the membrane and moved relative thereto reduces the thickness of the membrane to a specific uniform thickness and smooths the surface. The wavelength, power and pulse rate of the laser are selected which will smooth the fibrous surface as well as ablate the surface to the appropriate thickness. Alternatively, a dermatome is used to remove a layer of material from the fibrous surface of the membrane. Thinning may also employ compression. Stepwise compression with cross-linking to stabilize the membrane is used to avoid damaging the membrane through inelastic compression. Rather, the membrane is bound in the elastic compressed state through addition cross-linking. The foregoing several thinning techniques may be employed together to achieve strong thin membranes.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.16/154,353, filed Oct. 7, 2018, now U.S. Pat. No. 11,213,385, which is acontinuation of U.S. patent application Ser. No. 15/357,990, filed Nov.21, 2016, now U.S. Pat. No. 10,092,399, which is a continuation of U.S.patent application Ser. No. 13/950,154, filed Jul. 24, 2013, now U.S.Pat. No. 9,498,288, which is a continuation of U.S. patent applicationSer. No. 13/069,827, filed Mar. 23, 2011, now U.S. Pat. No. 8,846,390,which claims the benefit of U.S. Patent Application No. 61/316,801 filedon Mar. 23, 2010, and of U.S. Patent Application No. 61/381,858 filed onSep. 10, 2010, the entire disclosures all of which are incorporated byreference for all purposes.

FIELD OF THE INVENTION

The field of the present invention is the conditioning of bioprosthetictissues for use in implants and, more particularly, for methods forsmoothing and thinning sheet bioprosthetic tissue for use in prostheticheart valves.

BACKGROUND OF THE INVENTION

Medical technology has long been capable of replacing damaged ordiseased heart valves through open heart surgery. Such valves haveincluded mechanical devices as well as those using biological materialfrom humans (homograft tissue) and animals (xenograft tissue). The twoprimary types of prosthetic heart valves known in the art are mechanicalvalves and bioprosthetic valves. Bioprosthetic valves may be formed froman intact, multi-leaflet porcine (pig) heart valve, or by shaping aplurality of individual flexible leaflets out of bovine pericardialtissue or other materials, and combining the leaflets to form the valve.One advantage of bioprosthetic valves, unlike mechanical valves, is thatthe patient receiving the valve typically does not require long termtreatment with anticoagulants.

The pericardium is a sac around the heart of vertebrate animals whichcontains lubricating fluid, and bovine (cow) pericardium is commonlyused to make individual leaflets for prosthetic heart valves. The bovinepericardium is first harvested from the animal and then chemically fixedto crosslink collagen and elastin molecules in the tissue and increasethe tissue durability, before being cut into leaflets.

A good discussion of the various physical properties of fixed bovinepericardium is given in Simionescu, et al., “Mapping ofGlutaraldehyde-Treated Bovine Pericardium and Tissue Selection ForBio-prosthetic Heart Valves”, Journal of Bio-Medical Materials Research,Vol. 27, 697-704, John Wiley & Sons, Inc., 1993. Simionescu, et al.,recognized the sometimes striking variations in physical properties ofthe pericardial tissue, even in the same pericardial sac.

The pericardial sac consists of two distinct elements of tissue. Thevisceral or serous layer is of very thin translucent tissue mostadjacent the heart which is not used to construct artificial heart valveleaflets. This inner layer of the pericardium is conical and surroundsthe heart and the roots of the great blood vessels. The parietalpericardial membrane is a thicker membrane of multi-layered connectivetissue covered with adipose tissue. The outside fat/adipose tissue isremoved (e.g., peeled off) when harvested. The remaining multi-layeredfibrous tissue primarily contains collagen fibers with a generallyfibrous outer surface and a smooth inner surface. This remainingmembrane is used for making the leaflets for artificial heart valves.

A number of steps in a typical commercial process for preparingpericardial tissue for heart valve leaflets are illustrated in FIG. 1.First, a fresh pericardial sac 20 is obtained from a regulationslaughterhouse. The sac 20 is then cut open along predeterminedanatomical landmarks, as indicated at 22. The sac is then flattened at24 and typically cleaned of excess fat and other impurities. Aftertrimming obviously unusable areas, a window 26 of tissue is fixed,typically by immersing in an aldehyde to cross-link the tissue, and thenquarantined for a period of about two weeks. Normally, two windows of 4to 6 inches on a side can be obtained from one bovine pericardial sac.Rough edges of the tissue window 26 are removed and the tissuebio-sorted to result in a tissue section 28. The process of bio-sortinginvolves visually inspecting the window 26 for unusable areas, andtrimming the section 28 therefrom. Subsequently, the section 28 isfurther cleaned as indicated at 30.

The section 28 is then placed flat on a platform 32 for thicknessmeasurement using a contact indicator 34. The thickness is measured bymoving the section 28 randomly around the platform 32 while a spindle 36of the indicator 34 moves up-and-down at various points. The thicknessat each point is displayed at 38 and recorded by the operator. Aftersorting the measured sections 28 by thickness, as indicated at 40,leaflets 42 are die cut from the sections, with thinner leaflets 42generally being used for smaller valves, and thicker leaflets being usedfor larger valves. Of course, this process is relatively time-consumingand the quality of the final leaflets is dependent at several steps onthe skill of the technician. Moreover, the number of leaflets obtainedfrom each sac is inconsistent, and subject to some inefficiency from themanual selection process. One solution to this time-consuming manualprocess is provided in U.S. Pat. No. 6,378,221 to Ekholm, et al., inwhich a three-axis programmable controller manipulates a pericardialsheet with respect to a thickness measurement head to topographicallymap the sheet into similar thickness zones for later use. However, evenwith advanced methods the variability of the bovine pericardium resultsin an extremely low yield of sheet usable for heart valve leaflets;averaging less than 2 sheets per sac.

Typically, harvested bovine pericardial tissue ranges in thickness from250 microns up to 700 microns, though most of the material is between300-700 microns thick.

Valves using flexible leaflets, such as those made of bovine pericardialtissue, have acquired increased significance of late because thesevalves may be implanted by other than open heart surgery. The valves areconstructed using radially expandable stents with flexible (e.g.,pericardial) leaflets attached. Implant methods include compressing thevalve radially by a significant amount to reduce its diameter ordelivery profile, inserting the valve into a delivery tool, such as acatheter or cannula, and advancing the delivery tool to the correctanatomical position in the heart. Once properly positioned, the valve isdeployed by radial expansion within the native valve annulus, eitherthrough self-expanding stent structure or with an expansion balloon. Thecollapsed valve in the catheter may be introduced through thevasculature, such as through the femoral artery, or more directlythrough an intercostal incision in the chest. The procedure can beaccomplished without open heart surgery and possibly without stoppingthe heart during the procedure.

One example of percutaneous heart valve delivery is U.S. Pat. No.6,908,481 to Cribier and Edwards Lifesciences of Irvine, CA, which showsa valve prosthesis with an expandable frame on which a collapsiblevalvular structure is mounted. Another compressible/expandable heartvalve is shown in U.S. Patent Publication No. 2010/0036484, also fromEdwards Lifesciences. Further examples of such methods and devices aredisclosed in U.S. Pat. No. 7,621,948 and US Patent Publication No.2006/0259136, and the number of other configurations of such valves isexploding as the promise of the technology grows. The disclosures ofeach of these references are incorporated herein by reference.

These new devices require thinner components that enable crimping of thevalve down to a size that can pass through the delivery tool. Onelimiting component is the thickness of the bioprosthetic tissue. Asmentioned, pericardial layers range from 250-700 microns, but only asmall percentage of the harvested pericardium falls close to the lowend, which is the most useful for compressible/expandable valves.

U.S. Pat. No. 7,141,064 proposes compressing bovine pericardium toreduce its thickness by about 50 percent for use in heart valveleaflets. The compression may also smooth out the tissue surface toreduce thickness non-uniformity.

Despite much research into various bioprosthetic tissue, in particularfor heart valve leaflets, there remains a need for thinner and moreconsistent thickness tissues for use in fabricating smaller deliveryprofile bioprostheses.

SUMMARY OF THE INVENTION

The present invention is directed to the preparation of bioprostheticmaterial for cardio implantation. Bovine pericardial membrane having afibrous surface and a smooth surface are selected. This preparation canincrease the yield of cardio valve leaflets from pericardial membraneand can eliminate thrombogenic agents such as dangling fibers.

In accordance with one aspect, a method for preparing bioprosthetictissue membrane material includes first selecting a tissue membrane(e.g., bovine pericardial membrane) having a fibrous side and a smoothside. Material is then removed from the fibrous side of the selectedmembrane to reduce the thickness of the membrane and smooth the fibrousside. The material may be removed by shearing with a mechanical device,such as a dermatome or vibratome. Alternatively, the material may beremoved by ablation with a laser.

In the just-described method, the selected membrane may be conditionedby compressing the selected tissue membrane and cross-linking thematerial of the membrane while under compression. Furthermore, themethod may involve treating the membrane reduced in thickness by cappingof calcification nucleation sites and/or by borohydride reduction. Inaccordance with one aspect, the method further comprises at leastpartially fixing the selected membrane prior to the removing step.

In accordance with another method disclosed herein, bioprosthetic tissuemembrane material is prepared by first selecting a tissue membranehaving a fibrous side and a smooth side, conditioning the selectedtissue membrane by compression and cross-linking the membrane whileunder compression, and then removing conditioned material from thefibrous side of the selected tissue membrane to reduce the thickness ofthe membrane and smooth the fibrous side. The tissue membrane maybepericardial membrane, such as bovine or equine. The method may involvetreating the membrane reduced in thickness by capping and/or byborohydride reduction. In accordance with one aspect, the step ofremoving is accomplished by shearing with a mechanical device, such as adermatome or vibratome. Or, the step of removing is accomplished byablating the conditioned material with a laser.

In accordance with a still further aspect, a method for preparingbioprosthetic tissue membrane material comprises first selecting atissue membrane having a fibrous side and a smooth side. The material ofthe membrane is the least partially cross-linked, and then infused witha second cross-linking material of a chain length to allow spending oflarge inter-fibril domains. Subsequently, the tissue membrane is theleast partially compressed. The tissue membrane may be bovinepericardial membrane. The method may also involve lightly compressingthe selected membrane prior to at least partially cross-linking themembrane. The method may include treating the membrane reduced inthickness by capping and/or by borohydride reduction. In accordance withone aspect, material is removed from the fibrous side of the lightlycompressed tissue membrane.

Another aspect of the present application is a heart valve comprising aplurality of leaflets each made of sheet tissue having a first regionwith a uniform first thickness and a second region with a uniform secondthickness greater than the first thickness. The leaflets preferably eachhave a cusp edge opposite a free edge, and the second region extends ina generally uniform width strip along the cusp edge. The second regionalso may extend in a generally uniform width strip along the free edgeof each leaflet. Furthermore, the second region may extend in generallyuniform width strips radially from the center of the free edge to thecusp edge. Desirably, transitions between the thicknesses of the firstand second regions is gradual. In one embodiment, the heart valveincludes a support frame to which peripheral edges of the leafletsattach with sutures, and the second region extends along the leafletedges through which sutures are passed.

In a first separate aspect of the invention, a dermatome is employedwith the fibrous surface of the membrane and moved relative thereto tosmooth the surface and/or reduce the thickness of the membrane to aspecific uniform thickness, for instance no more than 250 microns. Thedermatome is constrained by spacers to control the thickness of themembrane remaining with the shaved material removed.

In a second separate aspect of the invention, the fibrous surface of themembrane is removed to smooth the surface and/or reduce the thickness ofthe membrane to a specific uniform thickness. The membrane is firstsubjected to light compression and cross-linking to smooth the fibroussurface and improve the material for ablation.

In a third separate aspect of the invention, a laser is directed at thefibrous surface of the membrane and moved relative thereto to ablate thesurface to smooth the surface and/or reduce the thickness of themembrane to a specific uniform thickness. The wavelength, power andpulse rate of the laser are selected which will smooth the fibroussurface as well as ablate the surface to the appropriate thickness. Themembrane may first be subjected to light compression and cross-linkingto smooth the fibrous surface and improve the material for ablation.

In a fourth separate aspect of the present invention, the selectedbovine pericardial membrane is first at least partially cross-linked,then infused with a second cross-linking material of a chain length toallow spanning of large inter-fibril domains. The membrane is thencompressed, and may then be treated by capping and borohydridereduction.

In a fifth separate aspect of the present invention, any of theforegoing processes may be used in combination to greater advantage.

A further understanding of the nature and advantages of the presentinvention are set forth in the following description and claims,particularly when considered in conjunction with the accompanyingdrawings in which like parts bear like reference numerals.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will now be explained and other advantages and featureswill appear with reference to the accompanying schematic drawingswherein:

FIG. 1 illustrates a sequence of prior art steps for preparing andmeasuring the thickness of bovine pericardial tissue prior to formingleaflets from the tissue;

FIG. 2 is a perspective view of a representative embodiment of aprosthetic heart valve that may be made with tissue conditioned inaccordance with the present application;

FIG. 3 is a perspective view of a support frame that can be used in theprosthetic valve of FIG. 2;

FIG. 4 is a flattened view of a leaflet of the valve shown in FIG. 2;

FIG. 5 is a bottom perspective view of a valve leaflet structureconnected to a reinforcing skirt so as to form a leaflet assembly;

FIG. 6A depicts a side view of an exemplary prosthetic heart valvecrimped on a balloon delivery catheter;

FIG. 6B shows the prosthetic valve of FIG. 6A mounted on the balloondelivery catheter and in its expanded state;

FIG. 7 is a schematic view of a sequence of tissue conditioning ofpericardial membrane with laser ablation;

FIG. 8 is a flattened plan view of a valve leaflet showing a reinforcingregion formed by uniformly thick tissue adjacent the bottom edge of theleaflet;

FIG. 9 is an edge view of a valve leaflet showing a reinforcing region;

FIG. 10 is a plan view of a prosthetic heart valve leaflet having athickened peripheral edge in areas where sutures penetrate forattachment to a structural stent;

FIGS. 10A and 10B are sectional views through a radial midline of theleaflet of FIG. 10 showing two different thickness profiles;

FIG. 11 is a plan view of a prosthetic heart valve leaflet having athickened peripheral edge in areas where sutures penetrate forattachment to a structural stent as well as a thickened free edge toreduce the risk of elongation at that location;

FIGS. 11A and 11B are sectional views through a radial midline of theleaflet of FIG. 11 showing two different thickness profiles;

FIG. 12 is a plan view of a prosthetic heart valve leaflet having athickened peripheral edge in areas where sutures penetrate forattachment to a structural stent as well as a thickened triple pointarea in the free edge simulating nodules of Arantius;

FIGS. 12A and 12B are sectional views through a radial midline of theleaflet of FIG. 12 showing two different thickness profiles;

FIG. 13 illustrates in plan view an alternative leaflet having athickened peripheral edge region, a thickened strip along the free edge,and a plurality of thickened radial strips extending from the free edgeto the cusp edge;

FIGS. 14A and 14B are schematic views of exemplary leaflet skivingprocesses utilizing contoured forming molds;

FIG. 15A is a schematic view of a dermatome cutting tissue, while FIG.15B illustrates the result on a generic section of pericardial tissue;

FIG. 16 is a schematic side view of a press with the near spacer removedfor clarity.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

In the primary embodiment, the preparation of leaflets for prostheticheart valves, in particular expandable heart valves, is described. Theleaflets are desirably incorporated in expandable prosthetic heartvalves that are initially crimped (or even rolled) into a small deliveryprofile or diameter to be passed through a catheter or other deliverysystem and then expanded at the implantation site, typically a valveannulus. The heart valves comprise structural stent bodies with aplurality of flexible leaflets incorporated therein. Various materialsare suitable for the stent body, although certain nickel-titanium alloys(i.e., Nitinol) are preferred for their super-elasticity andbiocompatibility. It should also be noted that specific stent bodyconfigurations are not to be considered limiting, and variousconstruction details may be modified.

Although forming prosthetic heart valve leaflets to be thinner helpsreduce the delivery size of expandable valves, forming thinner leafletsas well as conditioning the leaflets as described herein is believed tobe advantageous for conventional heart valves as well. For example,smoothing the rough surface of pericardial tissue is believed to improvedurability of the leaflets by reducing loose fibers and attendantthrombogenicity.

Heart valves with durability in excess of 10 years have had bovinepericardial leaflet thicknesses ranging from 0.014-0.023 inches(˜350-580 microns), with smaller valves utilizing thinner leaflets andlarger valves having thicker leaflets. Current percutaneous valves mayemploy porcine pericardial tissue with thicknesses down to 0.004-0.005inches (˜100-130 microns). Although naturally-occurring porcine tissueis somewhat thinner than naturally occurring pericardial tissue, thereare certain advantages to using pericardial leaflets.

Various tissues may be used for the leaflets, though a preferred tissuefor use in the primary application of heart valve leaflets is bovineparietal pericardial membrane. Though the thickness and strength ofbovine pericardial tissue is considered desirable for longer lastingvalves, other bioprosthetic tissue such as porcine, equine and othermammalian pericardium, including human, may be used. Furthermore, tissuefrom other anatomical sources may be used, such as dura mater,peritoneum, diaphragm, or others. Any tissue membrane that has asuitable durability and elasticity as pericardium is a candidate, thoughthose of skill in the art will appreciate that certain materials may bebetter suited for any one specific application. In general, tissues thatcontain fibrous collagen, in particular classed as Type I or Type IIIcollagen, and elastic fibers or elastin may be suitable for use infabricating heart valve leaflets. Other potential types of collagen thatcan be used are hybrid natural collagen solution or electrospun collagenelastin fabric. Also, certain so-called engineered tissue may be used,which are synthesized by growing collagenous tissue over a typicallymesh frame or scaffold. These source are collectively referred to as“tissue membranes,” and may all benefit from the principles describedherein, though some like bovine pericardium is especially well-suitedfor conditioning heart valve leaflets in accordance with the presentapplication.

As mentioned above, the pericardial sac consists of two or more distinctlayers, one side being relatively smooth while the opposite surfacecomprises connective tissue covered with adipose tissue, some of whichis peeled off when harvested, and is thus fibrous. The methods describedherein are particularly useful for smoothing out the fibrous side toform a consistently thick and smooth membrane. In some cases, thethickness of the fibrous adipose tissue side may also be reduced toproduce a uniformly thin membrane, preferably below 30o microns for usein collapsible/expandable valves.

With reference to FIG. 2, an exemplary one-piece prosthetic heart valve50 is shown that can utilize a bovine membrane of uniform thickness. Thevalve 50 will be described in some detail to illustrate some of thebenefits of the leaflet fabrication methods described herein, but morespecifics on the valve structure may be found in U.S. Patent PublicationNo. 2010/0036484, filed Jun. 8, 2009, entitled “LOW PROFILETRANSCATHETER HEART VALVE,” and assigned to Edwards Lifesciences, thedisclosure of which is incorporated herein by reference. Alternatively,another minimally-invasive valve that may utilize thin pericardialmembrane is found in U.S. Pat. No. 6,733,525, issued May 11, 2004,entitled “ROLLED MINIMALLY INVASIVE HEART VALVES AND METHODS OF USE,”which disclosure is expressly incorporated herein by reference.

Valve 50 in the illustrated embodiment generally comprises a structuralframe, or stent 52, a flexible leaflet structure 54 supported by theframe, and a flexible skirt 56 secured to the outer surface of theleaflet structure. The illustrated valve 50 may be implanted in theannulus of the native aortic valve, but also can be adapted to beimplanted in other native valves of the heart or in various other ductsor orifices of the body. Valve 50 has a “lower” or inflow end 60 and an“upper” or outflow end 62. Blood flows upward freely through the valve50, but the flexible leaflet structure 54 closes to prevent reversedownward flow. The flexible leaflet structure 54 thus provides flexiblefluid occluding surfaces to enable one-way blood flow.

Valve 50 and frame 52 are configured to be radially collapsible to acollapsed or crimped state for introduction into the body on a deliverycatheter and radially expandable to an expanded state for implanting thevalve at a desired location in the body (e.g., the native aortic valve).Frame 52 can be made of a plastically-expandable material that permitscrimping of the valve to a smaller profile for delivery and expansion ofthe valve using an expansion device such as the balloon of a ballooncatheter. Exemplary plastically-expandable materials include, withoutlimitation, stainless steel, a nickel based alloy (e.g., anickel-cobalt-chromium alloy), polymers, or combinations thereof.Alternatively, valve 50 can be a so-called self-expanding valve whereinthe frame is made of a self-expanding material such as Nitinol. Aself-expanding valve can be crimped and held in the collapsed state witha restraining device such as a sheath covering the valve. When the valveis positioned at or near the target site, the restraining device isremoved to allow the valve to self-expand to its expanded, functionalsize.

Referring also to FIG. 3 (which shows the frame alone for purposes ofillustration), the frame 52 is a generally tubular, stent-like structurehaving a plurality of angularly spaced, vertically extending struts, orcommissure attachment posts 64. The reader will note that the posts 64in FIG. 3 are somewhat modified from those shown in FIG. 2, thedifferences being minimal. The posts 64 are interconnected via severalrows of circumferentially extending struts 66. Thinner vertical (axial)struts 68 intermediate the commissure attachment posts 64 connect to andextend between adjacent horizontal rows of struts 66. The struts in eachrow are desirably arranged in a zigzag or generally saw-tooth patternextending in the direction of the circumference of the frame as shown.Adjacent struts in the same row can be interconnected to one another asshown to form an angle when expanded, desirably between about 90 and 110degrees. This optimizes the radial strength of frame 52 when expandedyet still permits the frame 52 to be evenly crimped and then expanded inthe manner described below.

Leaflet structure 54 desirably comprises three separate connectedleaflets 70 such as shown in FIG. 4, which can be arranged to collapsein a tricuspid arrangement, as best shown in FIGS. 2 and 5. Each leaflet70 has a curved lower cusp edge 72 opposite a generally straight upperfree edge 74, and two commissure flaps 76 extending between the freeedge 74 and the lower edge 72. The curved cusp edge 72 forms a singlescallop in the leaflet structure 54. When secured to two other leaflets70 to form the leaflet structure 54, the curved cusp edges 72 of theleaflets collectively form a scallop-shaped lower edge of the leafletstructure (as best shown in FIG. 5). As further shown in FIG. 4, tworeinforcing bars 78 can be secured to each leaflet 70 adjacent to flaps76 (e.g., using sutures). The flaps can then be folded over bars 78 andsecured in the folded position using sutures. If desired, each bar 78can be placed in a protective sleeve (e.g., a PET sleeve) before beingsecured to a leaflet.

Leaflets 70 attach to one another at their adjacent sides to formcommissures 80 of the leaflet structure (see FIG. 2 at the edges wherethe leaflets come together). Leaflet structure 54 can be secured toframe 52 using various techniques and mechanisms. For example, as bestshown in FIG. 2, commissures 80 of the leaflet structure desirably arealigned with the support posts 64 and secured thereto using suturesthrough holes 82 (FIG. 3). The point of attachment of the leaflets tothe posts 64 can be reinforced with the bars 78 (FIG. 4), whichdesirably are made of a relatively rigid material (compared to theleaflets), such as stainless steel.

As mentioned, the lower edge of leaflet structure 54 desirably has anundulating, curved scalloped shape. A suture line 84 visible on theexterior of the skirt 56 in FIG. 2 tracks the scalloped shape of theleaflet structure 54. By forming the leaflets with this scallopedgeometry, stresses on the leaflets are reduced, which in turn improvesdurability of the valve. Moreover, by virtue of the scalloped shape,folds and ripples at the belly of each leaflet (the central region ofeach leaflet), which can cause early calcification in those areas, canbe eliminated or at least minimized. The scalloped geometry also reducesthe amount of tissue material used to form leaflet structure, therebyallowing a smaller, more even crimped profile at the inflow end of thevalve.

Referring again to FIGS. 2 and 5, the skirt 56 can be formed, forexample, of polyethylene terephthalate (PET) ribbon. The leafletstructure 54 attaches to the skirt via a thin PET reinforcing strip 88(or sleeve), FIG. 5, which enables a secure suturing and protects thepericardial tissue of the leaflet structure from tears. The leafletstructure 54 is sandwiched between skirt 56 and the reinforcing strip88. The suture 84, which secures the reinforcing strip and the leafletstructure 54 to skirt 56 can be any suitable suture, and desirablytracks the curvature of the bottom edge of leaflet structure 54, as seeon the exterior of the skirt 56 in FIG. 2. The skirt 56 and leafletstructure 54 assembly resides inside of frame 52 and secures to thehorizontal struts 66 via a series of zigzag pattern sutures 86, as shownin FIG. 2.

To assemble, the heart valve leaflets 70 are cut from a membrane such asbovine pericardium and thinned, conditioned or otherwise shaped inaccordance with the principles described herein. In the expandable valve50 described above, the leaflets 70 attach within the tubular stent fame52 and the three adjacent pairs of free edges 74 meet in the middle ofthe valve at coapting lines oriented equiangularly with respect to oneanother. The free edges 74 billow inward to meet along the coaptinglines. The assembled valve is then stored in a sterile fluid, typicallyglutaraldehyde, for a period prior to implantation.

FIG. 6A shows the prosthetic heart valve 50 crimped onto balloon 92 of aballoon delivery catheter 90. As explained herein, the thinning of thebioprosthetic tissue applied to the material for the leaflets helpsenable the outer diameter D of the assembled valve and balloon catheterto be as small as 6 mm. Expanded prosthetic heart valve sizes aretypically anywhere between 20 mm up to about 30 mm.

FIG. 6B shows an alternative embodiment of a prosthetic valve 100comprising a frame 102 and a leaflet structure 104 mounted to the insideof the frame (e.g., using sutures as shown and described above). Thevalve 100 is shown in its expanded state after the expansion balloon 92has been inflated. The size of the expanded valve 100 varies dependingon the patient, typically between 22 and 40 mm.

Implant methods include compressing the valve 50 radially by asignificant amount to reduce its diameter or delivery profile, insertingthe valve into a delivery tool, such as a catheter or cannula, andadvancing the delivery tool to the correct anatomical position in theheart. Once properly positioned, the valve 50 is deployed by radialexpansion within the native valve annulus with the expansion balloon 92.The collapsed valve 50 in the catheter may be introduced through thevasculature, such as through the femoral artery, or more directlythrough an intercostal incision in the chest. It is important for thevalve to be as small as possible. A large valve requires a largediameter catheter, which is difficult to push through the femoralartery, for example. To enable smaller constricted heart valves, themaker thins the tissue used to make the leaflets 70. Preferably theconditioning includes reducing the tissue thickness, but may alsoinvolve smoothing the tissue to result in a thin, constant-thicknessmembrane from which to cut leaflets. Or, the leaflets may be formedfirst and then thinned. There are a number of ways to thin the tissueincluding using laser ablation, as explained below.

It should again be noted that the thinned pericardial membrane describedherein may be used in various types of heart valves, includingconventional surgical valves. The method can also be used to merelysmooth out or “heal” the tissue surface to eliminate thrombogenic agentssuch as dangling fibers, without any appreciable thinning. Such smoothedtissue which remains relatively thick may be used in conventionalsurgical heart valves. One specific example, of conventional heartvalves that may utilize tissue in accordance with the present inventionis the Carpentier-Edwards® PERIMOUNT® line of Pericardial Bioprostheses,available from Edwards Lifesciences. The basic construction of thePERIMOUNT® valve is seen in U.S. Pat. No. 5,928,281, which disclosure isexpressly incorporated herein by reference.

Desirably, pericardial layers used for transcatheter heart valveleaflets are in the 250-500 micron range, and preferably closer to 250microns. Unfortunately, only a small percentage of the harvestedpericardium falls close to the 250 micron thickness. Most of thematerial is 300-700 microns. As a result, each pericardial sac onlyyields about 1-2 leaflets suitable for THV. However, the pericardialtissue used for building heart valves consists of multiple layers oftissue with similar components and the majority of the collagen fibersare parallel between layers. This unique structure has made it possibleto use various means, e.g., lasers, razors, to remove some of thetissue. The tissue removed desirably comes from the fibrous side fromwhich the adipose tissue was previously removed. This creates a moredefined thinner pericardial membrane with a more appropriate lowprofile.

With the advent of laser technology, ablation of corneal tissue hasbecome common. Excimer lasers have been used for such procedures.Reference is made to U.S. Pat. No. 4,840,175. Recent work with modelocking lasers with very short pulse lengths in Picosecond andFemtosecond ranges have also been considered to reduce heating. Lasershave also been used for cutting tissue, for ablation of heart muscle totreat arrhythmia and for dental applications. Two other disclosures ofthe use of lasers for tissue removal on humans are in U.S. Pat. No.7,022,119 to Holha and U.S. Pat. No. 7,367,969 to Stoltz, et al. Theselaser references are incorporated herein by reference. Laser ablationusing the laser assisted in situ keratomileusis process has also beensuggested to reduce the thickness of bovine pericardium to createmembrane tissue for a wide variety of uses including heart valves inU.S. Patent Publication No. 2007/0254005, the disclosure of which isincorporated herein by reference.

FIG. 7 schematically shows a sequence of events in ablatingbioprosthetic tissue in preparation for making implant components, suchas heart valve leaflets. To prepare the pericardial material for cardioimplantation, a membrane 110 of bovine pericardial membrane with thebulk of the outside fat/adipose tissue removed is selected having athickness of 250 microns or more (typically in the range of 300-700microns). The collagenous layer 112 shown on the underside which makesup the inner surface of the pericardial sac in vivo still has some ofthe outside fat/adipose tissue 114 attached thereto.

Tissue ablation may be accomplished with the membrane 110 exposed, forexample, in planar form, as indicated by the flow chart of FIG. 7. In aplanar configuration, the membrane 110 is fixed or held in anappropriate plane. A laser 116 is directed at the upper fibrous surface114 of the membrane 110 with a focal point adjusted for ablation at ornear the top of the collagenous layer 112. Alternatively, although notshown, the membrane 110 could be positioned on a rotating mandrel sothat an adjacent laser may remove tissue. Other physical configurationsfor creating relative tissue/laser movement are contemplated. Relativemovement between the laser 116 and the surface 114 is then effected toablate material from the membrane 110. Depending on the degree oftransparency of the membrane tissue to the laser beam, more than onepass may be needed to achieve the desired uniform thickness.

The specification for a laser found to be useful in the ablation ofpericardium for creating heart valve leaflets includes: a dual axisscanning lens; 2× beam expansion; 1550 nm wave length; 31.5 μJ pulseenergy on target; 1.6 W average power; 50 Hz repetition rate; 650 fspulse width (ref); 30 μm laser spot size; elliptical polarization; 112mm focal length; 400 mm/s coarse milling speed (20 μm fill spacing incross hatch pattern); and 800 mm/s fine milling speed (20 μm fillspacing in cross hatch pattern).

A substantial amount of technology has been developed for guiding lasersand ablating tissue with great precision. Corneal ablation has beenwidely practiced for almost two decades. This technology using excimerlasers has become common. Reference is made again to U.S. Pat. No.4,840,175, the disclosure of which is incorporated herein by reference.Recent work with mode locking lasers having very short pulse lengths inPicosecond and Femtosecond ranges with reduce heating has also beenstudied.

Milling machines for such precise work not on a patient are alsoavailable. Milling machines employing a laser having the abovespecifications as the operative tool found to be useful for convenientlyprocessing pericardium membranes have a 2-axis scanning laser head,tissue holders to facilitate loading the work into the machine, an X-Ytable to increase working area of the laser and an automatic tissueholder loading mechanism. Mechanisms as described can be employed toselectively ablate a mounted pericardium membrane to generate patternsof different thicknesses as discussed below.

The operation of the milling machine is automated according to inputdata defining the pattern and the coarseness of the cut. Typically suchmachines are arranged to control the depth of cut based on the specificheight of the surface being cut. With such an arrangement, the resultingsurface will reflect the precut contour. To avoid this result, a fixedreference may be used rather than the height of the surface being cut.In this way, the entire pattern on the work will lie in a plane witheach completed cut. Multiple cuts then are used to reach the desiredmembrane thickness.

To retain the appropriate longevity of pericardial membrane leaflets andachieve a sufficiently compact package to be inserted into positionthrough the femoral artery, a specific tissue thickness of the leafletsis required. For instance, a uniform thickness of 250 microns has beenfound particularly useful, though uniform thicknesses between 250-500microns may be suitable. The wavelength, power and pulse rate of thelaser 116, 120 are selected which will smooth the fibrous surface toeliminate thrombogenic agents as well as ablate the surface to theappropriate thickness. Various wavelengths may be appropriate for thisprocess without generating excess heat while also being efficient. Ifultra-short-pulsed lasers are used, it is believed that the laserwavelength does not significantly change the result. Leaflet sampleshave been made utilizing a 1550 nm wavelength.

This preparation can increase the yield of cardio valve leaflets frompericardial membrane. Indeed, it is expected that at least 5 heart valveleaflets may be obtained per pericardial sac using the methods disclosedherein.

Laser ablation of pericardium is understood to be advantaged ifperformed on dry tissue. This may be accomplished by first fixing thespecimen no with a glycerin-based treatment using glutaraldehyde orequivalent and drying the tissue prior to laser ablation. Such aglycerin-based drying process is disclosed in U.S. Patent PublicationNo. 2008/0102,439, published May 1, 2008, to Tian et al., the disclosureof which is incorporated herein by reference.

In addition to producing a single uniform thickness, the methodsdescribed herein also may be used to selectively thin the tissue toobtain regions of uniform but different thicknesses. One particularlyuseful example is shown in FIG. 8, which shows a heart valve leaflet 130having a peripheral region 132 that is thicker than the rest of theleaflet 134. In particular, the lower curved or cusp edge of the leafletcan be thickened for later securement to the skirt 56 described above.The thickened region 132 desirably includes a generally uniform widthstrip. This is similar to securing a reinforcing strip 88 as describedabove, and both techniques may be used for even greater reinforcement.Three such leaflets 130 can be prepared in the same manner and thenconnected to each other at their commissure edges in a tricuspidarrangement to form a leaflet structure, such as shown at 54 in FIGS. 2and 5. The reinforcing regions 132 on the leaflets collectively define aribbon or sleeve that extends along the lower edge portion of the insidesurface of the leaflet structure 54.

FIG. 9 illustrates an edge view of the leaflet 130 with a stressrelieved profile, having the reinforcing regions 132 transition slowlyin thickness as seen at ramps 136 to the thinner main portion 134 of theleaflet 130. The reinforcing regions 132 are illustrated somewhat roughto simulate microscopic tissue irregularities, though the same surfacemay be made smoother using certain techniques described herein. Thereinforcing regions 132 may define the maximum leaflet thickness T_(max)of between about 300-700 microns, while the thinner main portion 134desirably has a minimum leaflet thickness T_(min) of between about200-500 microns, and potentially thinner. More particularly, for smallerheart valves down to 17 or 19 mm, leaflet tissue having a minimumthickness T_(min) of between 150-250 microns is contemplated, whilelarger valve such as 26 mm valves may have tissue up to 350 microns. Onecontemplated embodiment is ultrathin tissue on the order of only 100microns. The maximum leaflet thickness T_(max) is desirably up to twicethe thickness of the thinner portion of the leaflet. In particularexample, a smaller valve of 19 mm may have leaflets with T_(min) ofbetween 150-250 microns, while the maximum leaflet thickness T_(max) inthe reinforced areas is up to 300-500 microns.

FIGS. 10-12 illustrate alternative thickness profiles in pericardialtissue prosthetic heart valve leaflets from the selective thinningprocesses described herein. Each of the leaflets is shown in plan viewand has an arcuate cusp edge 140, a generally straight free edge 142opposite the cusp edge, and a pair of oppositely-directed tabs 144 ateither end of the free edge. Each of the tabs 144 includes a taperedside 146 which transitions to the free edge 142. A central portion 148in each of the leaflets forms the fluid occluding surface thatoscillates in and out of the flow stream to alternately open and closethe valve. This shape is exemplary only, and other leaflet shapes areknown. Each of the leaflets shown in FIGS. 10-12 have the same shape,and thus the same element numbers for the shape characteristics will beused.

FIG. 10 illustrates a leaflet 150 having a thickened peripheral edgeregion 152 in areas where sutures penetrate for attachment to astructural stent (not shown). More particularly, the thickenedperipheral edge region 152 extends around the entire cusp edge 140 andup into at least a portion of the tabs 144. As mentioned, these areareas in which sutures are used to attach the leaflet to a supportingstent. The thickness of the peripheral edge region 152 may be up to 700microns, preferably between 300-700 microns. At the same time, thecentral portion 148 is formed to have a relatively small thickness, thusfacilitating a smaller delivery profile for valves that are compressed.For instance, a uniform thickness of 250 microns for the central portion148 is believed particularly useful to reduce the crimped profile ofcollapsible/expandable valves, though uniform thicknesses between250-500 microns may be suitable.

FIGS. 10A and 10B are sectional views through a radial midline(vertical) of the leaflet of FIG. 10 showing two different thicknessprofiles. In FIG. 10A, the thicker peripheral edge region 152transitions to the thinner central portion 148 at a relatively abruptstep 154. In contrast, FIG. 10B illustrates a gradual ramp 156 betweenthe thick edge region 152 and thinner central portion 148. The ramp 156is shown linear, although other contours such as curved or graduallystepped may be used. It is believed the more gradual ramp 156 provides amore desirable stress distribution and flow over the leaflet. It may bepossible to provide gradual transitions by adjusting the laser powerapplication. Another way to accomplish gradual ramps is to use a skivingtechnology in combination with a forming mold, as described below withreference to FIGS. 14A and 14B.

FIG. 11 is a plan view of a prosthetic heart valve leaflet 158 having athickened peripheral edge region 152 as seen in FIG. 10, as well as athickened strip 160 along the free edge 142. Prosthetic heart valvessometimes fail from elongation of the free edge of the leaflet where theleaflets come together, or coapt, which ultimately may cause prolapse ofthe valve. Providing the thickened strip 160 along the entire free edge142 reduces the risk of elongation, as the stresses experienced by freeedge are proportional to its thickness. FIGS. 11A and 11B again show twodifferent thickness profiles for the leaflets of FIG. 11, wherein thethickened peripheral edge region 152 and thickened strip 160 maytransition to the thinner central portion 148 at steps 162 (FIG. 11A) orat gradual ramps 164 (FIG. 11B).

Finally, FIG. 12 illustrates a heart valve leaflet 166 again having thethickened peripheral edge 152 in areas used for attachment to astructural heart valve stent. In addition, the leaflet 166 has athickened triple point area 168 in middle of the free edge 142simulating a nodule of Arantius. To clarify, the so-called triple pointin a heart valve leaflet is the point where the leaflet comes together(coapts) with the other leaflets in the center of the flow orifice.Because the three leaflets curve into the middle, a gap therebetween atthe triple point may be sufficient to cause regurgitation. In nativeleaflets, the center of the free edge sometimes has a thickened areaknown as the nodules of Arantius that tends to fill the gap at thetriple point. When using uniform thickness pericardial tissue for theleaflets, leakage can only be avoided by having a long coapting surfacethat requires extra leaflet material. However, that adversely impactsthe ability to compress a valve to a low profile, and sometimes resultsin distortion of the leaflet when it closes which might result in earlycalcification. By producing a thickened triple point area 168 in each ofthe leaflets, a nodule of Arantius may be simulated. The exemplarytriple point area 168 is shown as a small triangle in the center of thefree edge 142, although the shape could be curved such as a semi-circle,or other shapes. Furthermore, the triple point area 168 may be combinedwith the thickened strip 162 along the free edge 142, such as seen inFIG. 11. Indeed, any of the various thickened regions described hereincan be combined with other regions for a desired effect.

FIGS. 12A and 12B show two different thickness profiles for the leaflet166. FIG. 12A shows abrupt steps between the thinner central portion 148and both the thickened peripheral edge 152 and the thickened triplepoint area 168, while FIG. 12B shows gradual transitions at the samelocations.

FIG. 13 illustrates an alternative leaflet 170 of the presentapplication that may help reduce sagging in leaflets, which has beenfound as a cause of failure in some prosthetic heart valves. Resistanceto leaflet elongation is directly proportional to leaflet thicknessalong radial stress lines. Therefore, in addition to a thickenedperipheral edge region 152 and a thickened strip 160 along the free edge142, the leaflet 170 includes a plurality of thickened radial strips172, 174 extending from approximately the middle of the free edge 142 tothe arcuate cusp edge 140. The “radial lines” in this sense are drawn asif the cusp edge 140 was the edge of a circle centered in the middle ofthe free edge 142, though it should be understood that the cusp edge 140may not be defined by a single arc, and may not be centered at the freeedge 142. Typically, prosthetic the leaflets are symmetric about aradial midline, however, and thus one preferred arrangement includes athickened radial strip 172 along the midline (vertical), and symmetricthickened radial strips 174 either side of the vertical strip 172. Inthe illustrated embodiment, there are three strips; a midline strip 172and two radial strips 174 at approximately 30° angles from the middlestrip. It should also be noted that as illustrated, the variousthickened strips around the leaflet are of approximately the same width,though such does not have to be the case. For example, the cusp edgestrip 160 and radial strips 172, 174 may be substantially thinner thanthe edge region 152 through which sutures must pass.

As mentioned above, contoured forming molds may be used to creategradual thickness changes in the leaflets described herein. FIGS. 14Aand 14B are schematic views of exemplary leaflet skiving processesutilizing such molds. In FIG. 14A, a forming mold 176 includes a leafletsupporting surface having one side 178 lower than another side 180. Amilling tool such as a laser 182 passes over an upper surface of aleaflet 184 and can be controlled to remove material to a predeterminedreference plane. In this manner, the left edge of the leaflet remainsthicker while more material is removed from the right side to result ina thinner leaflet area in that location. In FIG. 14B, a second formingmold 186 includes a leaflet supporting surface having peripheral sides188 lower than a middle portion 189. Again, when a laser 182 passes overthe upper surface of the leaflet 184, and is controlled to removematerial down to a reference plane, more material will be removed fromthe central region of the leaflet. Of course, many different shapes offorming molds are contemplated, those illustrated in FIGS. 14A and 14Bbeing exemplary only.

The resulting uniform membrane is preferably treated to render itgenerally inert and safe for human implantation. The treatment typicallyincludes immersing the membrane in a chemical solution such asglutaraldehyde for a predefined period of time to rid the tissue ofmicrobial entities, or “bugs.” An exemplary quarantine period is about14 days. Alternatively or in addition, the completed membrane may betreated using capping of calcification nucleation sites and borohydridereduction to mitigate later in vivo calcification.

For instance, one contemplated sequence for conditioning tissue includesfirst cross-linking the tissue (e.g., bovine pericardium) with aglutaraldehyde-buffered solution. Next, the tissue may be heat treatedusing a process such as disclosed in U.S. Pat. No. 5,931,969 toCarpentier, issued Aug. 3, 1999, the disclosure of which is expresslyincorporated herein by reference. Subsequently, the thickness of thetissue may be reduced using any of the methods disclosed in the presentapplication. Finally, the thinner tissue may be treated with a cappingand/or reducing agent to mitigate later in vivo calcification, this mayalso include treating with a glycerol/ethanol solution. For prostheticheart valve leaflets, the tissue is then formed into leaflets, attachedto a surrounding heart valve support frame or other such components, andsterilized such as with ethylene oxide. After the tissue has beenmilled, stamped, sliced, laser ablated, drawn down, or extruded toreduce its thickness, calcification nucleation sites (e.g., aldehydesand Schiff bases) may be exposed which creates a propensity forcalcification. Treating with a capping agent (e.g., ethanolamine) areducing agent (e.g., sodium borohydride) and a collagen preservingagent (e.g. glycerol) caps the nucleation sites and preserves thecollagen integrity. This allows the tissue to be as durable as it wasbefore it was reduced in thickness. Furthermore, this process will alsoallow the tissue to be stored in a non-liquid (i.e., glutaraldehyde)environment. In other words, the process is especially suitable for drystorage of the tissue.

As noted above, the membrane may be at least partially cross-linked or“fixed.” Cross-linking the collagenous matrix provides stability priorto implantation to retard degeneration. Further, the fixation processgenerally operates by blocking reactive molecules on the surface of andwithin the donor tissue, thereby rendering it substantiallynon-antigenic and suitable for implantation. Fixing bioprosthetic tissuetypically involves contacting the tissue with a cross-linking agent,normally a solution. Exemplary fixing solutions for bioprosthetic tissuesuch as bovine pericardium include glutaraldehyde, formaldehyde, otheraldehydes, EDC, polyethylene glycol, etc. Other ways to fix tissueexist, including heating, irradiating, etc. The fixing step can helpmaintain the pericardium in a particular three-dimensional form ifundertaken after the membrane is otherwise prepared.

It should be understood that although cross-linking the tissue resultsin a somewhat easier to handle workpiece, the thinning may occur priorto cross-linking as well. Likewise, bulk tissue sheet may be thinnedfirst before or after fixing, or leaflets may first be cut from the bulkmembrane which are then thinned before or after fixing.

In addition to laser tissue removal described above, various mechanicaldevices for shearing tissue such as razor or planing devices may be usedto remove some of the tissue. For instance, a device having a flatplaten over which a planing razor or blade translates may be substitutedfor the linear laser configuration of FIG. 7. Other physicalconfigurations for creating relative tissue/razor movement arecontemplated, such as for instance using a lathe-like razor to smooththe outer surface of the tissue. Each of these devices may beautomatically or computer-controlled using an optical surface measuringcomponent to control the depth of cut. Abrasive tissue removal (e.g.,sanding or rasping) may also prove suitable, though the grit of the toolshould be relatively fine.

An instrument which is a particularly attractive mechanical system forthinning a sheet of pericardial tissue is a dermatome. A dermatome issurgically used to harvest thin slices of skin from a donor area to usefor skin grafts, particularly for grade 3 burns or trauma. These devicesdate from the 1930s and are well known surgical instruments. Dermatomeshave been manually, pneumatically or electrically operated. Uniformityof thickness of skin for grafting is not important to the degree neededfor a heart valve leaflet.

FIGS. 15A and 15B illustrate a dermatome 192 skiving a rough layer froma generic section of pericardial tissue. Rather than harvesting thinslices of material for use as heart valve leaflets from the membrane,the material 190 removed by the dermatome 192 is discarded in favor ofthe remaining pericardial membrane 194. To achieve a reliable sheetthickness, spacers 196 are employed upon which the dermatome 192travels. The surface material 190 shaved from the membrane 194 is thefibrous side of the pericardium. The membrane is placed on a rubber backboard 198 and clamped. The back board has a spacer 196 to either side ofthe membrane to act as rails to support the dermatome 192 as ittraverses the membrane 194. The dermatome 192 may also be controlled tolimit cutting to a desired pattern so that regions of different heightscan be produced. Using a mechanical means to produce a uniform thicknessadvantageously does not generate heat or chemical effects in thepericardial membrane. It should be understood that as used herein, theterm, “dermatome” refers to a dermatome, vibratome, or any othermechanical cutting or abrading device that functions similar to aconventional dermatome for shearing tissue.

To overcome the laser ablated resulting surface reflecting a precutcontour in another way, a first compression of the pericardial membranemay be employed. A compression sufficient to flatten surfaceirregularities and achieve a more uniform thickness may be undertakenbefore laser ablation. Flattening surface irregularities in this mannerhelps ensure that the laser ablation step results in a more uniformremoval of the surface. Conversely, without compression the laseroperation might follow the contour of an irregular surface and removethe same amount of material across its surface, resulting in anirregular end product. One other method to ensure that a regularstarting surface is ablated in a manner that results in a smooth surfaceis to control the laser milling machine using a referencing program thattells the laser to remove material relative to a fixed, uniform surfacelevel, as opposed to following the contours of the surface being milled.

Typical pericardial tissue is in equilibrium at around 78% water; andwater can be squeezed from the tissue. Excessive compression to achieveflattening of the fibrous surface and a more uniform thickness canstretch out and break the collagen polymer backbone, eliminating thecollagen “crimp” structure and destroying the tissue's intrinsicbioelasticity. Not exceeding the yield point, however, allows theintrinsic bioelasticity to rebound over time. A partial or completefixing of the pericardial membrane while under elastic compression canretain the advantageous effect of the compression pending laserablation. Even with reasonably minor compression, some bonds are broken,resulting in some free aldehyde, amine and acid groups. By fixing thepericardial membrane in this gently compressed state, bonds are createdto retain this state. Alternatively, the pericardial membrane tends notto fully rebound immediately. Laser ablation immediately followingcompression can mitigate elastic reexpansion.

Alternatively, a sequence of first conditioning surface irregularitiesand then compressing the tissue membrane may be employed. For example,larger surface irregularities on the fibrous side of pericardial tissuemay be smoothed using a laser, mill, or dermatome, after which thetissue is compressed using various methods as described herein.Preferably, the tissue is compressed while at the same time at leastpartially fixing the tissue to help prevent spring back. This sequencemay yield a more mechanical uniform tissue construct.

As noted above, gentle compression with fixing of the pericardialmembrane in the compressed state can smooth the fibrous surface of thepericardium and make the thickness more uniform. This compression andfixing may be employed before or after the thinning of the tissue. Afterthinning, a stabilization step using capping and borohydride reductioncan mitigate later in vivo calcification.

Even greater compression is possible, with or without the ablation ormachining process. If laser ablation or a machining process is used, thedegree to which the tissue is fixed after compression is somewhatimmaterial as a physical trimming rather than further compression isused. If fully fixed at a first, gentle compression, further compressiontends to be fully elastic unless the tissue is damaged. A process ofpartial fixing with gentle compression and then further fixing atgreater compression can be used to obtain a thinner final membrane withsignificant tensile strength.

An initial gentle compression and fixing step is considered above. Theprocess can also proceed without the initial gentle compression, butrather with initially at least partially fixing the tissue. Again,glutaraldehyde or other fixing agent or method may be used. This firstfixation sequence stabilizes the biomechanics of the tissue andpreserves the natural “crimp” structure of the collagen. Infusion with asecond fixing material of sufficient chain length to allow spanning oflarge inter-fibril domains can then result in a stable membrane. Di- orpoly-amine material of substantial chain length may be employed. Othercross-linking materials to span large inter-fibril domains include bothlinear and branched polyethyleneimine, polyvinyl alcohol and variousJeffamine polymers. Alternatively, the tissue may be oxidized with, forexample, sodium chlorite to convert the newly formed aldehydes tocarboxylic acids. These may then be coupled with the above amines usingEDC chemistry. Compression can occur either at the beginning of theprocess, of after the infusion with a second fixing material, or both.Laser ablation or machining may be interjected for smoothing or furtherthinning after either compression step, and/or after the first fixationstep. The tissue may be capped and reduced following the first fixationstep, or alternatively, the compressed and cross-linked tissue sheet maybe stabilized by capping and borohydride reduction after the formingprocesses. Further treatment can include drying and sterilization. Suchprocessing is described in U.S. Patent Publication No. 2009/0164005,published Jun. 25, 2009 to Dove et al., the disclosure of which isexpressly incorporated herein by reference.

Apparatus used in any one or all compression steps is illustrated inFIG. 16. Porous ceramic pressure plates 200, 202 are used to providerigid compression to the tissue 204. Dialysis membranes 206, 208 areinterposed between the plates 200, 202 and the tissue 204. The ceramicpressure plates 200, 202 allow free circulation of various chemicaltreatments into the tissue 204. The disposable dialysis membranes 206,208 are used to prevent clogging of the ceramic pressure plates 200,202, preventing the flow of solution during production. Spacers 210between the ceramic pressure plates 200, 202 to either side of thetissue 204 limits compression.

Another application for the thinning and conditioning processesdescribed herein is in the field of pericardial patches, made fromeither bovine or equine pericardium. The pericardial patch product maybe used as a construction material for tissue repair, such as aorticconduit, pericardium, vessels etc., which is very common in pediatricpatients with congenital cardiovascular diseases. One such commercialbovine pericardial patch available from Edwards Lifesciences comes insize of 4×6 inches (10×15 cm), though equine patches can be smaller (3×4inches). The pericardial patch product is usually treated with a similarprocess as with heart valve leaflets (may be slightly different forequine patches). One issue is that the pericardial patch may be toothick for some of those applications, so making the patch uniformlythinner would significantly improve its applicability. Also, there isoften substantial variability in thickness among the patches and indifferent locations within any given patch. A desirable uniformthickness for the final product can be ranged from 150 to 500 micronsdepending on the size of the patch product. The above-describedselective thinning may also benefit the patches with one edge or theentire periphery being formed thicker to help retain anchoring sutures.

Thus, improved methods for preparing pericardial material for cardioimplantation have been disclosed. While embodiments and applications ofthis invention have been shown and described, it would be apparent tothose skilled in the art that many more modifications are possiblewithout departing from the inventive concepts herein, and it is to beunderstood that the words which have been used are words of descriptionand not of limitation. Therefore, changes may be made within theappended claims without departing from the true scope of the invention.

What is claimed is:
 1. A method for preparing a bioprosthetic tissue,the method comprising: treating a fixed bioprosthetic tissue with acollagen preserving agent; and reducing a thickness of a pre-determinedportion of the fixed bioprosthetic tissue to produce a contouredbioprosthetic tissue; wherein the contoured bioprosthetic tissue has atleast two areas of tissue with different thicknesses from one another;and wherein the thickness of one of the at least two areas of tissue isup to twice the thickness of another of the at least two areas oftissue.
 2. The method of claim 1, wherein the fixed bioprosthetic tissuehas been treated with a fixative.
 3. The method of claim 2, wherein thefixative is a glutaraldehyde or a formaldehyde.
 4. The method of claim2, wherein the fixative is a1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC) or a polyethyleneglycol.
 5. The method of claim 2, further comprising compressing thefixed bioprosthetic tissue prior to the reducing.
 6. The method of claim5, wherein the compressing is performed during the treating of thebioprosthetic tissue with the fixative.
 7. The method of claim 2,wherein the treating of the bioprosthetic tissue with the fixative isperformed prior to the reducing.
 8. The method of claim 1, wherein thethickness of the pre-determined portion of the bioprosthetic tissue isin the range of about 150 microns to about 250 microns.
 9. The method ofclaim 1, wherein the thickness of the pre-determined portion of thefixed bioprosthetic tissue is about 100 microns.
 10. The method of claim1, wherein the reducing is performed using a laser.
 11. The method ofclaim 10, wherein the laser is a femtosecond laser.
 12. The method ofclaim 1, wherein the collagen preserving agent comprises glycerol. 13.The method of claim 12, wherein the reducing is performed after treatingthe fixed bioprosthetic tissue with the collagen preserving agent. 14.The method of claim 1, wherein the reducing is performed by removingmaterial from a fibrous side of the fixed bioprosthetic tissue.
 15. Themethod of claim 14, wherein the removing is performed by ablating thefibrous side of the fixed bioprosthetic tissue using a laser.
 16. Themethod of claim 14, wherein the removing is performed by shearing ormilling the fibrous side of the fixed bioprosthetic tissue using amechanical device.
 17. The method of claim 1, wherein the reducing isperformed by compressing the fixed bioprosthetic tissue.
 18. The methodof claim 17, further comprising further fixing the fixed bioprosthetictissue during the compressing using a second fixative.
 19. The method ofclaim 1, further comprising forming heart valve leaflets from thecontoured bioprosthetic tissue.
 20. The method of claim 19, wherein theforming comprises forming the heart valve leaflets so that each of theheart valve leaflets has a peripheral edge region, a free edge oppositethe peripheral edge region, and a central region surrounded by theperipheral edge region and the free edge.
 21. The method of claim 19,further comprising attaching the heart valve leaflets to one or both ofa skirt or a stent to form a bioprosthetic heart valve.
 22. The methodof claim 21, further comprising packaging the bioprosthetic heart valvein a non-liquid environment.
 23. The method of claim 22, furthercomprising sterilizing the bioprosthetic heart valve following thepackaging.
 24. A method for preparing a bioprosthetic tissue, the methodcomprising: reducing a thickness of a pre-determined portion of a fixedbioprosthetic tissue to produce a contoured bioprosthetic tissue; andtreating the contoured bioprosthetic tissue with one or both of acapping agent and a reducing agent; wherein the contoured bioprosthetictissue has at least two areas of tissue with different thicknesses fromone another; and wherein the thickness of one of the at least two areasof tissue is up to twice the thickness of another of the at least twoareas of tissue.
 25. The method of claim 24, wherein: treating thecontoured bioprosthetic tissue comprises treating the contouredbioprosthetic tissue with at least the capping agent; and treating thecontoured bioprosthetic tissue with at least the capping agent reducesthe propensity of the contoured bioprosthetic tissue to calcify in vivo.26. The method of claim 25, wherein treating the contoured bioprosthetictissue with at least the capping agent caps calcification nucleationsites associated with the contoured bioprosthetic tissue.
 27. The methodof claim 26, wherein the capping agent is an ethanolamine.
 28. Themethod of claim 26, further comprising treating the fixed bioprosthetictissue with a collagen preserving agent before the reducing.
 29. Themethod of claim 24, wherein: treating the contoured bioprosthetic tissuecomprises treating the contoured bioprosthetic tissue with at least thereducing agent; and treating the contoured bioprosthetic tissue with atleast the reducing agent reduces the propensity of the contouredbioprosthetic tissue to calcify in vivo.
 30. The method of claim 29,wherein the reducing agent is a borohydride.
 31. The method of claim 24,wherein treating the contoured bioprosthetic tissue comprises treatingthe contoured bioprosthetic tissue with both the capping agent and thereducing agent.
 32. The method of claim 31, further comprising treatingthe fixed bioprosthetic tissue with a collagen preserving agent beforereducing the thickness of the predetermined portion of the fixedbioprosthetic tissue.
 33. The method of claim 32, wherein the contouredbioprosthetic tissue is treated with the capping agent and the reducingagent after the reducing.
 34. A method for preparing a bioprosthetictissue, the method comprising: reducing a thickness of a pre-determinedportion of a fixed bioprosthetic tissue to produce a contouredbioprosthetic tissue; where in the contoured bioprosthetic tissue has atleast two areas of tissue with different thicknesses from one another.